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胸外科微创手术达到世界领先水平

2017-08-20 08:11:32   中国青年网

电视胸腔镜手术是近半个多世纪以来普胸外科领域最大的技术革命。微创的胸腔镜手术,一般是在患者胸部打3个小孔,其中1个放入胸腔镜,能将患者胸腔的内部情况清晰地展现在电视屏幕上,医生看着电视画面,通过另外2个操作孔将器械探入胸腔,深入检查或将病变组织切除。与传统的开胸手术相比,胸腔镜手术创伤小、恢复快、疼痛轻。

胸腔镜技术目前已经涵盖胸外科几乎所有的病种,改变了胸外科的诊疗模式。肺癌的发病率和致死率居各种癌症之首,是人类头号肿瘤杀手。以对体检发现的肺内小结节,因为太小,要想确诊只能通过切除活检。过去需要“开大胸”、胸壁切开20厘米~30厘米刀口,才能得到标本,损伤大、风险高、恢复难,不少病人因为害怕而选择临床观察,常常拖成晚期,失去手术治愈机会。放化疗靶向花几十万元,生存期通常小于3年。

我们团队自1992年最早把电视胸腔镜手术引入中国,并用于肺癌诊疗。现在,只需要2-3个1.5厘米的小刀口就能做完肺癌手术。创伤小,恢复快,病人依从性高,一经发现小结节就积极接受胸腔镜诊断和治疗,使外科干预肺癌的时间节点向早期前移。

现在手术治疗的肺癌病例中,早癌比例较过去增加35%,相应5年生存率提高43%。术后基本不需放化疗,多可长期生存和工作。

在我国大中城市,80%以上肺癌手术都是利用这种技术完成的。手术的质量、安全性和效果都明显好于原来的开胸手术。尤其是早期肺癌病人,90%以上能长期存活不复发。因为创伤小,病人的劳动能力和生活质量得到了极大保证。

因为肺部感染及油烟等原因,中国肺癌病人肺门良性肿大淋巴结与血管之间的粘连比其它很多国家的人都重,这明显增加了肺癌手术的难度。为破解这一难题,我们团队研究设计了更有效、更安全的解决之道,也就是《柳叶刀·肿瘤》杂志介绍的“王氏技术”。它的要领包括同一口同向双交叉的“王氏手法”、“血管鞘内解剖”、以及“隧道式游离叶间裂”等。全国肺癌手术统计数据显示,全国已经有44.5%的肺癌手术是采用这种独特技术完成的。与美国国家癌症数据库同期数据相比,我们的中转开胸率只有7.7%,相比美国的17.5%下降一半多;围术期病死率只有0.6%,而美国达1.5%,下降了三分之二。

通过25年探索和推广,我国胸腔镜手术单位从1992年的7个到现在中等以上医院几乎全都开展。北京、上海等大中型中心胸腔镜手术比例在90%以上,全国平均比例超过50%。胸外科常见病、肺癌和食管癌基本都是在胸腔镜下完成手术。我国胸外科的诊疗模式已从传统开胸转变为现代微创,胸外科的微创手术技术已经达到世界领先水平。

以胸外科最主要的病种肺癌来说,人民医院胸外科肺癌手术近几年胸腔镜比例已达95%。全国整体已超过50%。这一比例已超过欧洲的20%和美国的30%。并且高难度肺癌手术例数也远超欧美。

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